髌骨粉碎性骨折的手术治疗

目的:探讨治疗髌骨粉碎性骨折内固定方法的临床疗效。方法:72例髌骨粉碎性骨折患者,男53例,女19例;年龄16⁶5岁,平均34岁;左侧33例,右侧39例。闭合伤61例,开放伤11例。髌骨下极粉碎45例,髌底粉碎6例,全髌粉碎21例。内固定方式:钢丝环扎固定26例,克氏针张力带固定5例,镍钛聚髌器（NT-PC）固定41例,对其疗效作分析对比。结果:72例患者中有65例获随访,随访时间6个月⁵年。所有骨折均临床愈合,以术后不同时期膝关节功能和X线检查综合判断疗效,钢丝环扎固定、克氏针张力带固定、NT-PC固定三组中,术后下地行走平均时间分别为35、18、10d,术后正常步态平均时间分别为48、45、22d,屈膝90°时间分别为50、30、26d,三组优良率分别为79·2%、50·0%、91·9%。结论:NT-PC用于粉碎性骨折的治疗,避免了髌骨部分或全部切除,最大限度保存膝关节功能,是目前理想的内固定方法。

Surgical treatment of splintered patellar fracture

Objective:To investigate the clinical outcome of operative treatment on splintered patellar fracture by internal fixative methods.Methods:Seventy-two patients of patella fracture included 53 male and 19 female with average age of 34 years ranging from 16 to 65 years;There were 33 cases in left and 39 in right; 61 in closed injury and 11 in open injury.Comminuted fracture of patellar inferior were in 45,base fracture of patellar in 6,comminuted fracture of whole patellar in 21.The methods of fixation included steel bind in 26 cases,tension band wiring in 5,and NT-PC in 41.Analysis and comparison for therapeutic effect of these three methods were done.Results: Sixty-five of the 72 patients were followed up for 6 months to 5 years.All cases healed over.The curative effects were evaluated by the function of the knee joints and the results of X-ray examinations in different periods after operation.In group of steel bind,tension band wiring and NT-PC,the mean time of postoperative walking were respectively 35,18,10 days,the mean time of postoperative normal gait were respectively 48,45,22 days,the mean time of genuflex to 90 degrees were respectively 50,30,26 days.The excellent and good rates of steel bind(26 cases),tension band wiring (5 cases) and NT-PC (41 cases) were respectively 79.2%,50.0%,91.9%.Conclusion:NT-PC is used to treat splintered patellar fracture.It could avoid entire or part patellar excision and remain the function of knee joint extremely.It is an ideal method in the treatment of splintered patellar fracture.